European Stroke Organisation (ESO)-European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion
Por:
Turc, G, Tsivgoulis, G, Audebert, HJ, Boogaarts, H, Bhogal, P, De Marchis, GM, Fonseca, AC, Khatri, P, Mazighi, M, de la Ossa, NP, Schellinger, PD, Strbian, D, Toni, D, White, P, Whiteley, W, Zini, A, van Zwam, W and Fiehler, J
Publicada:
1 mar 2022
Ahead of Print:
1 feb 2022
Resumen:
Six randomized controlled clinical trials have assessed whether mechanical thrombectomy (MT) alone is non-inferior to intravenous thrombolysis (IVT) plus MT within 4.5 hours of symptom onset in patients with anterior circulation large vessel occlusion (LVO) ischemic stroke and no contraindication to IVT. An expedited recommendation process was initiated by the European Stroke Organisation (ESO) and conducted with the European Society of Minimally Invasive Neurological Therapy (ESMINT) according to ESO standard operating procedure based on the GRADE system. We identified two relevant Population, Intervention, Comparator, Outcome (PICO) questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if insufficient evidence was available to provide recommendations based on the GRADE approach. For stroke patients with anterior circulation LVO directly admitted to a MT-capable center ('mothership') within 4.5 hours of symptom onset and eligible for both treatments, we recommend IVT plus MT over MT alone (moderate evidence, strong recommendation). MT should not prevent the initiation of IVT, nor should IVT delay MT. In stroke patients with anterior circulation LVO admitted to a center without MT facilities and eligible for IVT <= 4.5 hours and MT, we recommend IVT followed by rapid transfer to a MT capable-center ('drip-and-ship') in preference to omitting IVT (low evidence, strong recommendation). Expert consensus statements on ischemic stroke on awakening from sleep are also provided. Patients with anterior circulation LVO stroke should receive IVT in addition to MT if they have no contraindications to either treatment.
Filiaciones:
Turc, G:
Univ Paris, Dept Neurol, GHU Paris Psychiat & Neurosci, INSERM,U1266,FHU NeuroVasc, Paris, France
Tsivgoulis, G:
Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Sch Med, Dept Neurol 2, Athens, Greece
Univ Tennessee, Hlth Sci Ctr, Dept Neurol, Memphis, TN USA
Audebert, HJ:
Charite Univ Med Berlin, Klin & Hochschulambulanz Neurol, Campus Benjamin Franklin, Berlin, Germany
Ctr Stroke Res Berlin, Berlin, Germany
Boogaarts, H:
Radboud Univ Nijmegen, Dept Neurosurg, Med Ctr, Nijmegen, Netherlands
Bhogal, P:
Barts NHS Trust, Dept Intervent Neuroradiol, Royal London Hosp, London, England
De Marchis, GM:
Univ Basel, Univ Hosp Basel, Neurol & Stroke Ctr, Basel, Switzerland
Fonseca, AC:
Univ Lisbon, Hosp Santa Maria CHLN, Fac Med, Dept Neurosci & Mental Hlth Neurol, Lisbon, Portugal
Khatri, P:
Univ Cincinnati, Dept Neurol, Cincinnati, OH USA
Mazighi, M:
Rothschild Fdn Hosp, Dept Intervent Neuroradiol, Paris, France
Univ Paris, Lariboisiere Hosp, AP HP Nord, FHU NeuroVasc,Stroke Unit, Paris, France
:
Germans Trias & Pujol Hosp, Dept Neurol, Stroke Unit, Barcelona, Spain
Schellinger, PD:
Ruhr Univ Bochum, Johannes Wesling Med Ctr Minden, Dept Neurol, Univ Hosp, Bochum, Germany
Ruhr Univ Bochum, Johannes Wesling Med Ctr Minden, Dept Neurogeriatr, Univ Hosp, Bochum, Germany
Strbian, D:
Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Toni, D:
Sapienza Univ Rome, Hosp Policlin Umberto I, Dept Human Neurosci, Rome, Italy
White, P:
Newcastle Univ, Newcastle Upon Tyne Hosp NHS Fdn Trust, Translat & Clin Res Inst, Newcastle Upon Tyne, Tyne & Wear, England
Whiteley, W:
Univ Edinburgh, Ctr Clin Brain Sci, Edinburgh, Midlothian, Scotland
Zini, A:
Maggiore Hosp, Dept Neurol, IRCCS, Ist Sci Neurol Bologna, Bologna, Italy
Maggiore Hosp, Stroke Ctr, Bologna, Italy
van Zwam, W:
Maastricht Univ, Dept Radiol & Nucl Med, Med Ctr, Maastricht, Netherlands
Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands
Fiehler, J:
Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany
Green Submitted, Bronze
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